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Background: Children with solid tumors deemed to be poor risk at diagnosis and those who fail to respond or recur after chemotherapy have adverse outcomes. We sought to increase the dosage of cyclophosphamide (CPA) in the VETOPEC regimen (vincristine, etoposide, and CPA) with a view to improving the response rate and survival., Procedure: Patients underwent peripheral blood stem cell (PBSC) harvest after standard dose VETOPEC (CPA 40 mg/kg/day for 3 days) followed by filgrastim. Those with sufficient PBSC received up to four intensive cycles (ICs) of VETOPEC with CPA dosages of 60-90 mg/kg/day for 3 days (escalated by 5 mg/kg/day in cohorts of at least five patients) followed by PBSC and filgrastim., Results: Of the 59 enrolled patients, 58 were treated with mobilization chemotherapy and 57 proceeded to PBSC harvest. From 1 to 4 VETOPEC ICs were administered to 51 patients. The maximum tolerated dosage of CPA was not reached. The best response rate during the ICs for patients with recurrent or refractory/progressive disease was 67%; overall survival was 28% at 5 years and 25% at 10 years. The response rate for patients with newly diagnosed high-risk tumors was 89%., Conclusions: The VETOPEC regimen with CPA dosages up to 90 mg/kg/day for 3 days followed by PBSC and filgrastim can be given in a timely manner with manageable toxicity. Outcomes were not improved when compared to prior VETOPEC studies. VETOPEC produces high response rates and warrants further evaluation in appropriate patients with newly diagnosed high-risk solid tumors., (Copyright © 2011 Wiley-Liss, Inc.)

This study investigated whether pegfilgrastim support would enable on-schedule delivery of dose-dense cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP-14) to elderly patients with non-Hodgkin's lymphoma (NHL). Thirty patients 60 years of age and older with aggressive NHL were evaluated after receiving up to six cycles of CHOP-14 supported with pegfilgrastim. The median age was 68 years (range 61 - 74). Forty-seven per cent of patients received full dose chemotherapy on schedule for all cycles (range 65 - 93). Chemotherapy was delayed in 10 patients and dose reduced in 15 patients. Hematological toxicity was the most common reason for delays and dose reduction. Six of nine patients (67%) achieved a peripheral blood CD34+ count of at least 20 cellsx106 L-1 on day 12 of cycle one. The delivery on schedule of dose-dense CHOP-14 to elderly patients with previously untreated aggressive NHL is safe and efficacious with once per cycle pegfilgrastim support.

The objective of this study was to assess the efficacy of the VETOPEC regimen, a regimen of vincristine and etoposide with escalating doses of cyclophosphamide (CPA), in pediatric patients with high-risk brain tumors. Three consecutive studies by the Australia and New Zealand Children's Cancer Study Group--VETOPEC I, Baby Brain 91, and VETOPEC II--have used a specific chemotherapy regimen of vincristine (VCR), etoposide (VP-16) and escalating CPA in patients with relapsed, refractory, or high-risk solid tumors. Patients in the VETOPEC II cohort were treated with very high dose CPA with peripheral blood stem cell (PBSC) rescue. We analyzed the subset of patients with high-risk brain tumors treated with these intensive VETOPEC-based protocols to assess the response, toxicity, and survival. We also assessed whether the use of very high dose chemotherapy with stem cell rescue improved the response rate or affected toxicity. Seventy-one brain tumor patients were treated with VETOPEC-based protocols. Of the 54 patients evaluable for tumor response, 17 had a complete response (CR) and 20 a partial response (PR) to treatment, which yielded an overall response rate of 69%. The CR + PR was 83% (19/23) for medulloblastomas, 56% (5/9) for primitive neuroectodermal tumors, 55% (6/11) for grade 3 and 4 astrocytomas, and 80% (6/8) for ependymomas. At a median follow-up of 36 months, overall survival for the entire cohort of 71 patients was 32%, with event-free survival of 13%. There were no toxic deaths within the PBSC-supported VETOPEC II cohort, despite higher CPA doses, compared with 7% among the non-PBSC patients. This regimen produces high response rates in a variety of very poor prognosis pediatric brain tumors. The maximum tolerated dose of CPA was not reached. Higher escalation in doses of CPA did not deliver a further improvement in response. With PBSC rescue in the VETOPEC II study, hematologic toxicity was no longer a limiting factor. The response rates observed support further development of this chemotherapy regimen.

Infusions of ex vivo-expanded (EXE) mobilized blood cells have been explored to enhance haematopoietic recovery following high dose chemotherapy (HDT). However, prior studies have not consistently demonstrated improvements in trilineage haematopoietic recovery. Three cohorts of three patients with breast cancer received three cycles of repetitive HDT supported by either unmanipulated (UM) and/or EXE cells. Efficacy was assessed by an internal comparison of each patient's consecutive HDT cycles, and to 106 historical UM infusions. Twenty-one cycles were supported by EXE cells and six by UM cells alone. Infusions of EXE cells resulted in fewer days with an absolute neutrophil count (ANC) <0.1 x 10(9)/l (median 2 vs. 4 d, P = 0.002) and 3 d faster ANC recovery to >0.1 x 10(9)/l (median 5 vs. 8 d, P = 0.0002). This resulted in a major reduction in the incidence of febrile neutropenia compared with UM cycles (0% vs. 83%; P = 0.008) and in 66% of historical UM cycles (P = 0.01) and a marked reduction in hospital re-admission. There were also fewer platelet transfusions required (43% vs. 100%; P = 0.009). We conclude that EXE cells enhance both neutrophil and platelet recovery and reduce febrile neutropenia, platelet transfusion and hospital re-admission.

1. A series of 1-benzylcycloalkylamines with cycloalkyl rings of five, six or seven carbons and with various benzyl ring substituents (3-Cl, 4-Cl, 4-F, 3-CF3) was prepared and tested for anorectic and motor activity effects in rats. 2. Two potent, non-stimulant, anorectics were found: 1-(3-chlorobenzyl)-cycloheptylamine, and its N-methyl analogue. The activity of these compounds resembled that of chlorphentermine.

Fifteen preterm infants with patent ductus arteriosus and respiratory distress syndrome were given indomethacin (0.2 mg/kg) at 12 h intervals up to three times, either orally or intravenously, in an uncontrolled, non-randomized study. Serum indomethacin concentrations were determined in blood samples taken 12 h after dosing. There was considerable variability in the serum indomethacin concentrations, especially after oral administration, although the mean concentrations after each of the three doses were similar after both oral and intravenous administration. The frequency of closures and transient closures of the ductus arteriosus was also similar for both routes of administration. There was, however, no relation between concentration and effect in individual patients. The sustained exposure to indomethacin which appears to be necessary for ductal closure can sometimes be attained by oral administration.

Cyclosporin A (CyA) was used to minimize graft-versus-host disease (GVHD) in 28 recipients of allogeneic marrow transplants. When given orally, the absorption of CyA was markedly dependent on normal gut function. Patients without gut dysfunction showed normal serum concentration-time curves while those with diarrhoea from any cause (chemo-radiation enteritis, acute GVHD of the gut, infectious enteritis) showed minimal absorption of the drug. These data indicate the desirability of the intravenous administration of CyA during periods of gut dysfunction in marrow transplant recipients.

The hypothesis that there is prostaglandin-mediated hypercalcaemia associated with the Walker carcinosarcoma in the rat was tested by measuring PGE production during the development of the hypercalcaemia, and determining the effects of inhibition of prostaglandin synthesis on serum calcium concentration. Parathyroid hormone (PTH) activity was estimated by the determination of the serum concentration of immunoreactive PTH. There was a 3-fold increase in the urinary excretion of 7α-hydroxy-5,11-diketotetranor-prostane-1,16-dioic acid (PGE-M), a major urinary metabolite of the E prostaglandins from basal levels. Treatment with indomethacin, a potent inhibitor of prostaglandin synthesis, did not lower serum calcium concentrations with two different doses (1·6 mg/kg/day orally and 5 mg/kg/day i.m.); effective inhibition of prostaglandin synthesis was demonstrated by the suppression of PGE-M excretion rates below basal levels. Serum concentrations of immunoreactive PTH were not significantly altered by either tumour growth or indomethacin. Dexamethasone (0·5 mg/kg/day i.m.) attenuated both the increased urinary excretion of PGE-M and the rise in serum calcium concentration, suggesting that one or several lipoxygenase products might be the actual mediators of the hypercalcaemia. We conclude that the hypercalcaemia in the rat with Walker carcinosarcoma is probably not mediated by E-prostaglandins and probably not by any other product of the cyclo-oxygenase pathway. The increased PGE turnover may be considered as a biochemical marker of tumour load, but not as an indicator of a prostaglandin-mediated hypercalcaemia.

The absorption and elimination of radioactivity after the oral or intraperitoneal administration of[4-14C]mofebutazone was studied in rats. The blood concentration of radioactivity reached a maximum after about 0.7 h, fell rapidly until about 2 h, and then declined slowly. There was sometimes a second peak between 3-6 h. Elimination of radioactivity in urine and feces was extensive and rapid. Over a 24 h period, 73% of the orally administered radioactivity was eliminated in the urine and 15% in the faeces; most of this was eliminated during the first 8 h (89% of the urine radioactivity, 56% of the faeces radioactivity). In anaesthetized rats with cannulated bile ducts, 94% of the intraperitoneally injected radioactivity was eliminated in the bile over a 6 h period. Most of the radioactivity (about 85%) eliminated in the bile and the urine was in the form of a glucuronide and only small amounts less than 10%, was in the form of mofebutazone.

1. A novel activity cage for rats is described. Eight light beams are aimed at a light-conducting perspex rod at the centre of a cylindrical cage. The photoresistor at the end of the rod detects the changes in light intensity produced by interruption of the light beams. 2. The apparatus is simple to operate and was capable of detecting small differences in the motor activity of groups of rats. 3. Dose-dependent increases in motor activity were produced by dexamphetamine (1.36 to 27.3 mumol/kg, i.p.). The depressant effects produced by 20 mumol/kg doses of nonfenfluramine were greater than those of fenfluramine. Large doses (100 mumol/kg) of tranylcypromine stimulated motor activity whereas its cis-isomer, cis-2-phenylcyclopropylamine, depressed motor activity.

1. A series of 1-(2-chloroacyl)ureas, related to the sedative-hypnotic drugs bromvaletone and carbromal, was synthesized and tested in mice to determine central depressant and acute toxic effects. Four 1-(2-bromoacyl)ureas and two 3-halo compounds were included for comparison. 2. Large variations in potency were seen between the compounds. Much of this can be ascribed to differences in lipophilicity. Among homologous 1-(2-chloroacyl)ureas, those with 6 acyl carbons had maximal potency. Among groups of structural isomers, the most potent were 2-halo, 3-alkyl substituted compounds. 3. The most potent compounds were also those with the largest ratios of hypnotic to lethal activity. 4. The variation in the onset and duration of action of these compounds enables a choice to be made for a compound with a particular set of characteristics.

A series of 1-(2-thienyl)-2-phenylethylamines was synthesized and tested for anorectic and motor activity effects in rats. Phenyl ring substituents included Cl, Br, F, CF3, CH3, OCH3, and NO2; amino group substituents included alkyl, benzyl and acetyl groups. About half of the compounds produced significant anorexia; only one of these active anorectics increased motor activity. The three most potent non-stimulant anorectics were: 1-(2-thienyl)-2-(4-chlorophenyl)ethylamine, its N-isopropyl analogue, and N-isopropyl-1-(2-thienyl)-2-(4-fluorophenyl)ethylamine.

1. The central depressant effects of bromvaletone, carbromal and six non-bromo analogues were compared in mice. 2. The chloro analogues of bromvaletone and carbromal were slightly less potent as central depressant agents than the bromo compounds. 3. The chloro analogue of bromvaletone had the greatest margin between central depressant and lethal doses. 4. Lipophilicity (octanol-water partition coefficient) did not provide a unifying relationship for potency within this group of eight acylureas. However, within each of the two subsets of compounds, a linear relationship was found between relative potency and lipophilicity.

A series of 1,2-diphenylethylamines has been synthesized in which the phenyl rings were substituted with Cl, OCH3 or CF3 at various positions and in various combinations. Four N-ethylpiperazino and N-ethylmorpholino compounds were also prepared. When tested in rats, some of the compounds were found to be potent anorectics and none of them stimulated motor activity.

1. The anorectic and motor activity effects of 1-aminoindane, 2-aminoindane, some N-substituted 2-aminoindanes, 2-aminotetralin, amphetamine and fenfluramine were determined in rats. 2. The two compounds with structures most like the extended conformation of amphetamine, 2-aminotetralin and 2-aminoindane, were potent anorectics. At dosages which halved the intake of food over 1 h, amphetamine increased motor activity, 2-aminotetralin had no effect, and 2-aminoindane reduced motor activity. 3. Both the anorectic and central stimulant actions of 2-aminoindane were absent in N-ethyl- and N-isopropyl-2-aminoindane. 4. 1-Aminoindane, whose structure is like the folded conformation of amphetamine, produced a small anorectic effect and depressed motor activity.